1
|
de Diego-Alonso C, Bellosta-López P, Blasco-Abadía J, Buesa-Estéllez A, Roldán-Pérez P, Medina-Rincón A, López-Royo MP, Giner-Nicolás R, Doménech-García V, Fini NA. The relationship between levels of physical activity and participation in everyday life in stroke survivors: A systematic review and meta-analysis. Disabil Health J 2024:101640. [PMID: 38777677 DOI: 10.1016/j.dhjo.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Stroke survivors demonstrate decreased physical activity (PA) and take time to return to participation in everyday life, but the relationship between the two variables is unknown. OBJECTIVE To investigate the correlation and trajectory over time between levels of PA and participation in everyday life in stroke survivors. METHODS PubMed, Web of Science, Scopus, SPORTDiscus, Rehabilitation&Sport Medicine Source, and PEDro databases were searched from inception to January 2024. Cross-sectional and prospective studies evaluating both levels of PA and participation in stroke survivors were included. Two reviewers independently conducted the study selection, data extraction, and quality assessment. Meta-analyses of pooled correlation coefficients were calculated when at least two studies reported a correlation coefficient between the same PA and participation outcomes. RESULTS Of 4962 studies identified, 49 were included in the systematic review. Studies were rated high (55%%) or fair (45%) quality. A wide range of monitoring methodologies for assessing PA and participation were found in the 23 prospective studies. Seven studies were included in the meta-analyses, showing a positive moderate correlation between PA time and participation in activities of daily living (n = 148; r = 0.52; P < 0.01; I2 = 81%) in participants <6 months post-stroke, and between PA time and the participation in all areas (n = 126; r = 0.44; P < 0.01; I2 = 0%) in participants ≥6 months post-stroke. Overall, while PA showed significant improvements over time, participation only showed a tendency. CONCLUSIONS Despite the heterogeneity, consistent positive associations were found between PA time and participation levels in some areas. Establishing consensus is crucial to reduce heterogeneity and facilitate data pooling.
Collapse
Affiliation(s)
- Cristina de Diego-Alonso
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain.
| | - Julia Blasco-Abadía
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Almudena Buesa-Estéllez
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Patricia Roldán-Pérez
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Almudena Medina-Rincón
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Pilar López-Royo
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Rafael Giner-Nicolás
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Natalie A Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
Collapse
Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
| |
Collapse
|
3
|
Bansal K, Clark DJ, Fox EJ, Rose DK. Sympathetic nervous system responses during complex walking tasks and community ambulation post-stroke. Sci Rep 2023; 13:20068. [PMID: 37974001 PMCID: PMC10654447 DOI: 10.1038/s41598-023-47365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Stroke survivors frequently report increased perceived challenge of walking (PCW) in complex environments, restricting their daily ambulation. PCW is conventionally measured through subjective questionnaires or, more recently, through objective quantification of sympathetic nervous system activity during walking tasks. However, how these measurements of PCW reflect daily walking activity post-stroke is unknown. We aimed to compare the subjective and objective assessments of PCW in predicting home and community ambulation. In 29 participants post-stroke, we measured PCW subjectively with the Activities-specific Balance Confidence (ABC) Scale and objectively through electrodermal activity, quantified by change in skin conductance levels (SCL) and skin conductance responses (SCR) between outdoor-complex and indoor-steady-state walking. High-PCW participants were categorized into high-change SCL (ΔSCL ≥ 1.7 μs), high-change SCR (ΔSCR ≥ 0.2 μs) and low ABC (ABC < 72%) groups, while low-PCW participants were categorized into low-change SCL (ΔSCL < 1.7 μs), low-change SCR (ΔSCR < 0.2 μs) and high-ABC (ABC ≥ 72%) groups. Number and location of daily steps were quantified with accelerometry and Global Positioning System devices. Compared to low-change SCL group, the high-change SCL group took fewer steps in home and community (p = 0.04). Neither ABC nor SCR groups differed in home or community steps/day. Objective measurement of PCW via electrodermal sensing more accurately represents home and community ambulation compared to the subjective questionnaire.
Collapse
Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Mount Union, 1972, Clark Ave, Alliance, OH, 44601-3993, USA.
| | - David J Clark
- University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
| | - Emily J Fox
- University of Florida, Gainesville, FL, USA
- Brooks Rehabilitation, Jacksonville, FL, USA
| | - Dorian K Rose
- University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
- Brooks Rehabilitation, Jacksonville, FL, USA
| |
Collapse
|
4
|
Larsson P, Bidonde J, Olsen U, Gay CL, Lerdal A, Ursin M, Mead GE, Edvardsen E. Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis. Int J Stroke 2023; 18:1063-1070. [PMID: 36622013 PMCID: PMC11044520 DOI: 10.1177/17474930231152132] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. AIMS Our systematic review and meta-analysis aimed to investigate PSF's associations with PA and fitness. SUMMARY OF REVIEW Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization's International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r = -0.24; 95% confidence interval (CI) = -0.33, -0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r = -0.09; 95% CI = -0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. CONCLUSIONS The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.
Collapse
Affiliation(s)
- Petra Larsson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Julia Bidonde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Unni Olsen
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie Ursin
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Gillian Elizabeth Mead
- Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|